Wang Lei, Fan Chao-Qiang, Ren Wei, Zhang Xia, Li Yi-Hui, Zhao Xiao-Yan
Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
Scand J Gastroenterol. 2011 May;46(5):627-33. doi: 10.3109/00365521.2011.561364. Epub 2011 Mar 3.
Submucosal myogenic tumors, including leiomyoma and stromal tumors, are currently treated primarily by open surgery or laparoscopic excision. The aim of this retrospective study was to evaluate the feasibility of endoscopic dissection (ED) for resecting endogenous esophageal leiomyoma (EL) and gastric stromal tumors (GSTs) with diameters of 5 cm.
We enrolled 42 patients with endogenous EL and GST who had undergone endoscopic surgery (endoscopic group). These cases were compared retrospectively with 22 patients who had undergone thoracotomy or laparotomy (control group). Endoscopic group (n = 42) received ED for EL and GST resection, including circumferential removal of superficial mucosa of targeted tumor. Control group (n = 22) received thoracotomy or laparotomy for resection of esophageal and gastric myogenic tumors. Main outcome measures were operative time, intraoperative bleeding and perforation, postoperative complications, and hospital stays and costs were compared between groups.
Endogenous EL and GST were successfully removed from all patients. Bleeding and perforation occurred in seven and five EL and GST patients, respectively. Bleeding was corrected with argon plasma coagulation (APC). Perforation was endoscopically repaired with clips. Mean operative time was 49 min for endoscopic EL and 55 min for GST resection. No major bleeding or perforation occurred postoperatively. Endoscopic treatment had shorter length of stay and lower hospital costs than conventional procedures.
ED is safe and feasible for resection of endogenous EL and GST in selected cases.
黏膜下肌源性肿瘤，包括平滑肌瘤和间质瘤，目前主要通过开放手术或腹腔镜切除进行治疗。本回顾性研究的目的是评估内镜下剥离术（ED）切除直径≤5 cm的内生性食管平滑肌瘤（EL）和胃间质瘤（GST）的可行性。
我们纳入了42例行内镜手术的内生性EL和GST患者（内镜组）。将这些病例与22例行开胸或开腹手术的患者（对照组）进行回顾性比较。内镜组（n = 42）接受ED切除EL和GST，包括环形切除目标肿瘤的浅表黏膜。对照组（n = 22）接受开胸或开腹手术切除食管和胃肌源性肿瘤。主要观察指标为手术时间、术中出血和穿孔情况、术后并发症，并比较两组的住院时间和费用。
所有患者的内生性EL和GST均成功切除。EL和GST患者分别有7例和5例发生出血和穿孔。出血通过氩离子凝固术（APC）纠正。穿孔通过内镜用夹子修复。内镜下切除EL的平均手术时间为49分钟，切除GST的平均手术时间为55分钟。术后未发生大出血或穿孔。与传统手术相比，内镜治疗的住院时间更短，住院费用更低。
在特定病例中，ED切除内生性EL和GST是安全可行的。
